Hemodialysis, peritoneal dialysis, and kidney transplant are the only treatment options available for patients with end-stage renal disease (ESRD). Despite the fact that Caucasians comprise the majority of ESRD patients, African Americans and individuals of lower socioeconomic status (SES) have disproportionately poorer survival. Self-management of dietary sodium and fluid restriction are critical to ensuring positive health outcomes for ESRD patients requiring hemodialysis, though not easily achieved. Studies targeting ways to assist African American/low SES patients to achieve these goals primarily focus on fluid restriction, rather than dietary sodium restriction, and few have explored how sociodemographic factors influence dietary modification success. Building on these observations, the purpose of this mixed-methods study is to explore the impact of sociodemographic and economic characteristics on dietary patterns when attempting to meet dietary goals for hemodialysis. The specific aims are to: 1. fully explore the problems and barriers perceived by a diverse hemodialysis patient population in their attempts to follow the hemodialysis diet, with specific attention to African American/low SES patients;2. describe dietary patterns (in particular sodium intake) and patterns of IDWG among hemodialysis patients;and 3. explore associations between variations in diet, interdialytic weight gain (IDWG), problems experienced, barriers and perceived self-efficacy and sociodemographic and economic characteristics. Subjects will be patients recruited from University of Pittsburgh Medical Center Renal Network who are: a minimum of 18 years of age, community dwelling, and on maintenance dialysis therapy for at least 3 months. Exclusion criteria are: inability to read or write;non-English speaking, intent to change dialysis center within 6 months, terminal illness or life expectancy of less than 12 months, planned receipt of living donor transplant, and lack of authority in dietary decision making. Subjects in the quantitative portion of the study wil be participants enrolled in an ongoing R01 (NR010135). Subjects in the qualitative portion will be selected using purposive and theoretical sampling from the participants who completed quantitative measures. The proposed study will be one of few to comprehensively examine patient's perceptions of dialysis dietary modification with emphasis on sociodemographic variations. The study will provide the essential evidence needed to assist patients to achieve dietary goals. Guided by a modified model, the study will use a mixed methods design to permit the researcher to capitalize on patient experiences expressed in both standardized instruments and probing interviews of each patient's unique dietary experience. PUBLIC HEALTH RELEVANCE: Chronic Kidney Disease and ultimately, end stage renal disease (ESRD) is a global health concern. Improved patient outcomes can potentially be achieved through interventions that promote behaviors that achieve dietary sodium intake and fluid restriction goals. Few studies have explored challenges faced by ESRD patients in terms of reduction in dietary sodium intake and none were identified that addressed the influence of sociodemographic and economic characteristics on dietary patterns.